Saline irrigation for the management of skin extravasation injury in neonates

Abstract

Extravasation injury is a common complication of neonatal intensive care and can result in scarring with cosmetic and functional sequelae. A wide variety of treatments are used in practice including subcutaneous irrigation with saline (with or without hyaluronidase), liposuction, use of specific antidotes, different topical applications and normal wound care with dry or wet dressings. All such treatments aim to prevent or reduce the severity of complications. To determine the efficacy and safety of saline irrigation or saline irrigation with prior hyaluronidase infiltration on tissue healing in neonates with extravasation injury when compared to no intervention or normal wound care. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 2), MEDLINE (1950 to June 2011), EMBASE (Jan 1980 to June 2011), CINAHL (Jan 1988 to June 2011) and the Web of Science (up to July 2011). Randomised controlled trials (RCT) and quasi-randomised controlled trials comparing saline irrigation with or without hyaluronidase infiltration with no intervention or normal wound care in the management of extravasation injury in neonates. Three review authors independently reviewed and identified articles for possible inclusion in this review. No eligible studies were found. There were a few case reports and case series describing successful outcomes with different interventions in this condition. To date, no randomised controlled trial is available that examines the effects of saline irrigation with or without prior hyaluronidase infiltration in the management of extravasation injury in neonates. Saline irrigation is a frequently reported intervention in the literature that is used in the management of extravasation injury in neonates. Research should be initially directed at evaluating the efficacy and safety of this intervention through randomised controlled trials. It will also be important to determine the size of the effect according to timing of intervention, nature of the infusate and the severity of injury at the time of intervention.